Read an Excerpt
The Curable Disease
At age 75, Martha Davis had a ruptured appendix. Both she and her doctors were surprised because a rupture of the appendix rarely occurs at that age. Her doctors puzzled over her case until they received a report from the pathologist. Under the microscope, a sample of tissue taken from her appendix during surgery revealed a cluster of cancerous tumor cells. A tumor is one of the few conditions known to cause a ruptured appendix in the elderly.
In order to determine the appropriate treatment, the doctors discussed the "Davis Case" among themselves. They knew the duster of tumor cells had been completely removed at surgery. Still, there was the unlikely but theoretical possibility that when the appendix burst some cancer cells may have spilled onto the lining of the abdomen. Because some of those malignant cells might not have been removed at the time of surgery, her physicians, after much debate, decided it would be best if Mrs. Davis received aggressive treatment. When they presented their treatment plan they simply told Mrs. Davis that she should undergo chemotherapy and radiation. They did not explain how they arrived at their treatment decision nor did they reveal their colleague's misgivings about such aggressive therapy.
Behind closed doors, Mrs. Davis and her family privately questioned the doctor's aggressive recommendations and asked for additional studies to determine whether there was any evidence that cancer was still present in her body. The tests revealed no tumor.
Mrs. Davis respected her doctors but she was stilluncomfortable with their advice. She and her family believed that chemotherapy and radiation were excessive. After all, she was 75 years old; the tumor had been completely removed and the side effects of treatment would be uncomfortable and possibly dangerous.
Mrs. Davis and her family agonized over all the information. Finally, she informed her doctors that she did not want the aggressive treatment; she would rather wait and see if the cancer reappeared. To her surprise, her doctors agreed with her. They said they had felt obligated to offer her the most aggressive approach, despite the fact that they didn't really think the cancer would likely recur. The family felt frustrated and wondered why the doctors hadn't just told them that in the first place.
This true story underscores how difficult it can be for doctors and patients to communicate. The doctors among themselves considered all available treatment options but they never communicated any of that decision-making process to the patient or her family. They never explained how they decided to recommend aggressive therapy. Mrs. Davis, who from the onset was uncomfortable with the proposed care, faded to express her dismay directly to the doctors and never asked for an explanation as to why aggressive chemotherapy and radiation were necessary, There was incomplete communication on both sides, and both parties could have done better.
Communication is indeed a two-way street. If you can change the way you communicate with your doctor, it will in turn change the way your doctor communicates and cares for you. Communication is one of the best ways, if not the best way, for patients to influence their care. But patients are often reluctant to take an active role and responsibility for their part in patient/ doctor communication.
The word patient comes from the Greek word pathos, which means suffering. And for centuries, patients have literally been passive sufferers, obeying their doctors without question. The belief that the doctor is the expert with all the answers disempowers the patient and perpetuates the role of passive sufferer. In turn, this passive attitude of patients often interferes with the doctor's ability to deliver quality care. Your doctor can never know precisely what you are feeling; nor can he or she understand all the complex changes that are occurring in your health and body day-to-day unless you communicate that information. While the doctor has more knowledge of your disease initially, you and your family can educate yourselves so that you can become experts in your disease. By effectively communicating, you assist your doctor in the process of caring for you and your family.
Although this chapter is written primarily for the patient, it is our hope that doctors and health care providers will also be drawn to this information in order to better understand the relationship between patient and care giver. In the meantime, there are stepsyou can take today, as a patient, to begin improving communication with your caregiver. We start by exploring how and why doctors communicate the way they do.
How Come My Doctor Can Do Brain Surgery, But He Doesn't Know How talk To Me?
The answer is simple. Your doctor has been trained to be a doctor (to do brain surgery), but he has not necessarily been taught how to communicate effectively. He may not know the first thing about how to talk to patients because nobody ever taught him. Students are selected for medical school because of their scientific interests and abilities, not because of communication skills or teaching abilities. These communication skills are underemphasized in medical school. Instead, medical students learn how to diagnose and cure disease. They may never learn how to convey information to the patient.
So what can you, the patient, do to improve communication? You are 50 percent of the process. By improving your communication skills, your doctor might very well improve the way he communicates with you.
If you've been to a doctor, you've heard DoctorSpeak: You come in complaining of an itch, and your doctor says you have puritus. That lump on your foot you call a bunion gets the tongue-twisting name hallux valgus-metatarsus adductus. DoctorSpeak is a medical foreign language. Every area of science, from anthropology to zoology, has its own specialized language or jargon. Medicine is no different. DoctorSpeak is the specialized language doctors use to talk to each other. Unfortunately, it is often the way they talk to their patients, as well.